Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Am J Gastroenterol. 2010 Mar;105(3):663-73; quiz 674. doi: 10.1038/ajg.2009.650. Epub 2009 Nov 10.
A higher proportion of colorectal neoplasia among women occurs in the proximal colon, which might be more frequently missed by colonoscopy. There are no data on predictors of developing colorectal cancer (CRC) after a negative colonoscopy in usual clinical practice. We evaluated gender differences and predictors of CRC occurring after a negative colonoscopy.
All individuals 40 years or older with negative colonoscopy were identified from Manitoba's provincial physicians' billing claims database. Individuals with less than 5 years of coverage by the provincial health plan, earlier CRC, inflammatory bowel disease, resective colorectal surgery, or lower gastrointestinal endoscopy were excluded. CRC risk after negative colonoscopy was compared to that in the general population by standardized incidence ratios. Cox regression analysis was performed to determine the independent predictors of CRC occurring after negative colonoscopy.
A total of 45,985 individuals (18,606 men; 27,379 women) were followed up for 229,090 person-years. After a negative colonoscopy, men had a 40-50% lower risk of CRC diagnosis through most of the follow-up time. Risk among women was similar to that of women in the general population in the first 3 years and then was 40-50% lower. Older subject age and performance of index colonoscopy by non-gastroenterologists were independent predictors for early/missed CRC (cancers occurring within 3 years of negative colonoscopy).
Women may have a higher rate of missed/early CRCs after negative colonoscopy. Predictors of missed/early CRCs after negative colonoscopy include older age and performance of index colonoscopy by a non-gastroenterologist.
女性结直肠肿瘤的高发部位在近端结肠，而结肠镜检查可能更容易遗漏这些部位。目前，在常规临床实践中，尚缺乏结肠镜检查阴性后发生结直肠癌（CRC）的预测因素数据。本研究旨在评估结肠镜检查阴性后发生 CRC 的性别差异和预测因素。
从马尼托巴省的省级医生计费索赔数据库中确定所有年龄在 40 岁或以上且结肠镜检查结果为阴性的个体。排除覆盖省级医疗保险不足 5 年、CRC 发病更早、炎症性肠病、结直肠切除术或下胃肠道内镜检查的个体。通过标准化发病率比比较结肠镜检查阴性后 CRC 的风险。采用 Cox 回归分析确定结肠镜检查阴性后发生 CRC 的独立预测因素。
共纳入 45985 名个体（男性 18606 名，女性 27379 名），随访时间为 229090 人年。结肠镜检查阴性后，男性在大部分随访时间内发生 CRC 的风险降低 40%-50%。女性在前 3 年的风险与一般人群中的女性相似，随后降低 40%-50%。年龄较大和非胃肠病专家进行结肠镜检查是早期/漏诊 CRC（结肠镜检查阴性后 3 年内发生的癌症）的独立预测因素。
女性在结肠镜检查阴性后可能有更高的漏诊/早期 CRC 发生率。结肠镜检查阴性后漏诊/早期 CRC 的预测因素包括年龄较大和非胃肠病专家进行结肠镜检查。
